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Nurses are the best!

“No man, not even a doctor, ever gives any other definition of what a nurse should be than this -- 'devoted and obedient.' This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman.”

-Florence Nightingale, 1859

This is Nurses’ Week (May 6-12) and the celebration of Florence Nightingale’s birthday. Please take a moment to celebrate the nurses in your life. Florence Nightingale was the first to publicly decry the sorry reputation of nurses - as in the quote - but nurses remain vastly underappreciated for the work they do. Let’s take a moment to consider how nurses contribute to the interdisciplinary teams in the nursing home, the hospital, the hospice, and the clinic.

I think we’ve underappreciated the role of nurses as teachers. I must give thanks first to the nurses who have taught me and continue to teach me. As a physician-in-training and now as a junior attending, nurses have taught me at least as much about clinical medicine and caring for patients as any other group except patients. From nurses I’ve been amazed to learn what home health and hospice can accomplish at home, the limits of what can be done in the nursing home, and really practical advice like patients should lie on their left side when infusing an enema (it’s a straighter shot into the colon, if you were wondering).

Nurse practitioners were the first ones to practice gerontology and palliative care in many places, and have been the senior-most clinical mentors to many of us. When I was at the Brigham, when we ran out of ideas for treatment of complex pain, we often turned to Maureen Lynch, the NP and senior clinician on the palliative care team for advice. Patrice Villars is the senior clinician at the SF VAMC and I routinely look to her for advice on how to approach complex and challenging patients. Nurse practitioners, being both clinicians and nurses, are uniquely able to navigate challenging issues and dynamics that arise between nurses, physicians, patients, and families.

There is an expression, “Nurses are on the front lines,” that certainly applied in Florence Nightingale’s time - she described being “up to her elbows in blood,” caring for British soldiers in the Crimean war - and still applies today. Nurses are there, in the room, when the patient and family have stopped putting on their best face for the doctors. They have contributed to countless family meetings, as witnesses to the everyday experiences of patients and families: joy and suffering, hope and fear, loss and renewal.

And physicians, let’s stop claiming ownership of the nurses we work with, as in, “This is my nurse X.” It’s demeaning and emphasizes a hierarchy that is antithetical to highly functioning interdisciplinary teams. Thanks, Patrice, for this perspective – you see, I’m learning!

So say thank you to each other if you’re a nurse, and if not, say thank you to the nurses you know! Happy Nurses Week!

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In honor of Florence Nightingale's birthday, let us also acknowledge that in addition to being a frontline clinical nurse, Florence Nightingale was a great scientist. Those of us who do health services or health outcomes research owe a debt of gratitude to Nightingale, who we must recognize as one of the founders of our discipline.

Nightingale was a pioneer in establishing links between quality of care and infection rates. More than a century before the landmark, "To Err is Human" report, she decried the serious impact inadequate quality of care in London hospitals had on patient morbidity and mortality. She was one of the first to suggest we could compare patient outcomes across facilities as a measure of health care quality.

Florence Nightingale's birthday is a great time to reflect on the importance of the nursing profession as we work to improve the care of our patients.

Some time we want to get extrinsic rewards in our life, such as money, car, nice house and so on and other times we like to get intrinsic rewards such as self-fulfilment, eureka moments, deepening our understanding how the universe works. And at the end of our lives, ultimately intrinsic rewards are more satisfying like following the path of Florence Nightingale.

The one guarantee we have in our health care system is that everyone will have an encounter with a nurse. From the tireless work of the bedside nurse aide providing personal care, the discharge planner who gets your grandparent to the right rehab center, the oncology nurse who infuses chemo with compassion, the home health nurse that makes sure you are using your glucometer properly and dresses your wounds, to the COO running your local hospice, nurses are everywhere. Personally, I love this post (http://health.gather.com/viewArticle.action?articleId=281474978220653) at gather.com on national nurses week. As an NP provider, doctors sometimes tell me (with love) that I am really one of them. I’m not. I’m a nurse and I couldn’t be more proud.

Thanks, Alex, for the kind words about nurses. I had forgotten the quote by Nightingale. Goes with being the "handmaid of the physician" (though I guess I would be the "handyman"). The reality of healthcare today, which you elude to, is the collaboration between all providers, whether physician, nurse, social worker, pharmacist or PT/OT. This team work is what results in the best care possible, and we are each an integral and vital part of the process. In regards to another comment you made, it is "when the patient and family have stopped putting on their best face for the doctors" that I have had my most rewarding experiences as a nurse. And I appreciate the doctor who comes back later and asks me "So, how did it go?"

As a male, I frequently am asked why I didn't "just" become a doctor. The best response I have been able to come up with is "I think I make a better nurse." And I say it with pride.

A tender handReaching out to calm the stormy seaOf his foggy senses and pain-racked vesselChecking signs of illness, level of concernBut also lovingly stroking his skin and hairLike he was a boy, scraped on the pavementNeeding comfort and safety

A reassuring lookNot that she will be free from painBut that you will be with herAnd make it better, somehowAnd not leave her aloneAnd not let her be in the darkBe by her side

An attentive earTo hear a plea for reliefOr the quiet breathing of restful sleepA loved one’s questions never too manyHis whisper for a little waterAnd a story about joys of last yearBefore all this trouble began

A heartfelt wordHere is your medicineHere comes your family down the hallYour doctor is on the wayHow about a sponge bath?What else can I do for you?I am sorry this is so hard

Nurses assess, monitor, and treatProblem solvers extraordinaireBut more than all that skill and attentionWhat they provide above all elseIs a healing touch in every moveIn their hand, eyes, ears, and speechAnd in their unflinching presence

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